Purpose: C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, postoperative day (POD) 1, and POD 7 CARs and the prognosis of patients with colorectal cancer (CRC). Methods: Three hundred twenty patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into 2 groups, high CAR and low CAR (n=72/group), based on preoperative, POD 1, and POD 7 CARs. The relapse-free survival (RFS) and overall survival (OS) were compared between groups using propensity score matching. Results: The high CAR group had a significantly worse RFS (P<0.001) and OS (P=0.002) at POD 7 than those in the low CAR group. However, in preoperative and POD 1 analysis, no differences were observed. Conclusion In patients with CRC, CAR of POD 7 was a significant prognostic factor.

Objective: Prolonged use of Kampo medicines containing Gardenia fruit can cause mesenteric phlebosclerosis. A cumulative dose exceeding 5,000 g of Gardenia fruit may trigger this condition. However, the Japanese Pharmacopoeia 18th edition only specifies the minimum geniposide content in Gardenia fruits, making it difficult to assess the risk based solely on the cumulative Gardenia fruit dose. Hence, we evaluated mesenteric phlebosclerosis risk concerning cumulative geniposide intake in the current study. Quantitative analyses were conducted on ethical Kampo extract formulations containing Gardenia fruit. Methods: Ethical Kampo extract formulations containing Gardenia fruit were separately extracted using an H2O/methanol (1:1) solution and the resulting extracts underwent filtration. Each filtrate underwent quantitative, high-performance liquid chromatography analysis. Results: Significant variation was observed in the geniposide quantities among various ethical Kampo extract formulations containing identical amounts of Gardenia fruit in each daily dose. Additionally, the extracts of orengedokuto, kamishoyosan, and bofutsushosan obtained from various companies exhibited maximum differences in geniposide quantities ranging from 1.5- to 2.7-fold. Conclusion: This study highlights the challenges in accurately assessing geniposide levels in ethical Kampo extract formulations containing Gardenia fruit solely based on the daily dose of Gardenia fruit. The potential development of mesenteric phlebosclerosis should be considered based on the cumulative intake of geniposide rather than the cumulative dose of Gardenia fruit. Additionally, the study offers recommendations regarding the optimal geniposide quantities in ethical Kampo extract formulations containing Gardenia fruits.

Objective: Sennosides A and B, which are dianthrone glycosides contained in Rhubarb and Senna Leaf, exhibit laxative effect. Although a number of over-the-counter (OTC) drugs used as laxatives contain Rhubarb or Rhubarb and Senna Leaf, the total amounts of sennosides A and B are not mentioned in the package insert. To determine the total amounts of sennosides A and B in OTC drugs containing Rhubarb or Rhubarb and Senna Leaf, quantitative analyses of sennosides A and B were performed for 24 OTC drugs.Methods: Sennosides A and B were extracted from 24 OTC drugs and quantitatively analyzed by high-performance liquid chromatography. Statistical analyses were carried out by a one-way analysis of variance followed by Dunnett's test or Tukey's test.Results: The OTC drugs contained sennosides A and B in the range of 1.5-10 mg in the minimum daily dosage and in the range of 2.7-17 mg in the maximum daily dosage. In 11 of the OTC drugs (Products Nos. 1-5, 11, 12, and 15-18), the maximum daily dosage contained almost equal or higher amounts of sennosides A and B compared to that in a tablet of the prescription medicine Pursennid® 12 mg. Furthermore, the amounts of sennosides A and B in the maximum daily dosage were significantly higher in products Nos. 1 and 11 and lower in products Nos. 8-10, 14, and 20-24 compared to those of a tablet of Pursennid® 12 mg.Conclusion: Although some OTC drugs have the same Rhubarb content, the total amounts of sennosides A and B can vary. Thus,there is no correlation between the Rhubarb content and total amounts of sennosides A and B. This is because of the inconsistent quality of Rhubarb and/or the differences in the manufacturing methods of the OTC drugs containing Rhubarb. Because the total amounts of sennosides A and B cannot be estimated based on the Rhubarb content, a constipated patient should start taking an OTC drug containing Rhubarb at the minimum daily dosage. It is also recommended that the total amounts of sennosides A and B are mentioned in the package insert of OTC drugs containing Rhubarb or Rhubarb and Senna Leaf.